Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study

<p>Abstract</p> <p>Background</p> <p>The directly observed therapy-short course (DOTS) strategy was introduced in Shaanxi province, China to improve tuberculosis (TB) control by means of improved case detection (target: > = 70%) and treatment success rates (target: &...

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Main Authors: Zhang Hongwei (Author), Sun Xiaolu (Author), Zhao Yan (Author), Zhang Tianhua (Author), Guo Liujia (Author), Men Ke (Author), Ai Xianqin (Author), He Guangxue (Author), van der Werf Marieke (Author), van den Hof Susan (Author)
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Published: BMC, 2010-03-01T00:00:00Z.
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042 |a dc 
100 1 0 |a Zhang Hongwei  |e author 
700 1 0 |a Sun Xiaolu  |e author 
700 1 0 |a Zhao Yan  |e author 
700 1 0 |a Zhang Tianhua  |e author 
700 1 0 |a Guo Liujia  |e author 
700 1 0 |a Men Ke  |e author 
700 1 0 |a Ai Xianqin  |e author 
700 1 0 |a He Guangxue  |e author 
700 1 0 |a van der Werf Marieke  |e author 
700 1 0 |a van den Hof Susan  |e author 
245 0 0 |a Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study 
260 |b BMC,   |c 2010-03-01T00:00:00Z. 
500 |a 10.1186/1471-2458-10-112 
500 |a 1471-2458 
520 |a <p>Abstract</p> <p>Background</p> <p>The directly observed therapy-short course (DOTS) strategy was introduced in Shaanxi province, China to improve tuberculosis (TB) control by means of improved case detection (target: > = 70%) and treatment success rates (target: > = 85%) in new smear positive (SS+) TB patients. At a provincial level the targets were both reached in 2005. However in 30 (28%) out of 107 counties of Shaanxi province the cure rate was below 85%. This study aimed to investigate patient and treatment characteristics associated with non-cure after tuberculosis (TB) treatment in these counties.</p> <p>Methods</p> <p>In this case-control study, new smear positive TB cases in 30 counties with a cure rate <85% were included. Cured patients were compared to non-cured patients using logistic regression analysis to assess determinants for non-cure.</p> <p>Results</p> <p>Of the 659 patients included, 153 (23.2%) did not have cure as treatment outcome. Interruption of treatment was most strongly associated with non-cure (OR = 8.7, 95% CI 3.9-18.4). Other independent risk factors were co-morbidity, low education level, lack of appetite as an initial symptom of TB disease, diagnosis of TB outside of the government TB control institutes, missing sputum re-examinations during treatment, and not having a treatment observer. Twenty-six percent of patients did not have a treatment observer. The non-cure rate was better for those with a doctor (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.17-0.88) as treatment observer than for those with a family member (OR 0.62, 95%CI 0.37-1.03). The main reason for interrupted treatment mentioned by patients was presence of adverse effects during treatment (46.5%).</p> <p>Conclusions</p> <p>Interruption of treatment was most strongly associated with non-cure. Although treatment observation by medical staff is preferred, in order to diminish the proportion of patients who do not have a treatment observer and thereby reduce the proportion of patients who interrupt treatment, we suggest making it possible for family members, after sufficient training, to be treatment observers in remote areas where it is logistically difficult to have village doctors observe treatment for all patients.</p> 
546 |a EN 
690 |a Public aspects of medicine 
690 |a RA1-1270 
655 7 |a article  |2 local 
786 0 |n BMC Public Health, Vol 10, Iss 1, p 112 (2010) 
787 0 |n http://www.biomedcentral.com/1471-2458/10/112 
787 0 |n https://doaj.org/toc/1471-2458 
856 4 1 |u https://doaj.org/article/5f842f1146fb4c738c70b29231c2a43b  |z Connect to this object online.